Why do you not recommend testing HBV DNA? I've seen in previous postings that you don't recommend testing of HBV DNA unless liver function tests become abnormal.Why is this?

Response from Dr. McGovern

The issue of monitoring HBV DNA depends on the circumstance. When a patient comes for their initial evaluation, markers of viral replication should be drawn (Hepatitis B e antigen and HBV DNA).

When a patient is seen in follow-up and has normal liver function tests, but is known to be viremic, I do not necessarily follow viral load levels. I am much more interested in the liver function tests in this situation. This is due to the fact that studies show poor treatment response rates in patients who have normal liver function tests.

Therefore, I wait to see if the liver function tests may change over time. If they do, then that is the time I want to discuss treatment with the patient.

On treatment, the HBV DNA becomes a very important marker of drug response.

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